Abstract
Precision medicine is changing cancer care and placing new demands on oncology professionals. Precision medicine trials for high-risk childhood cancer exemplify these complexities. We assessed clinicians’ (n = 39) and scientists’ (n = 15) experiences in the first year of the PRecISion Medicine for Children with Cancer (PRISM) trial for children and adolescents with high-risk cancers, through an in-depth semi-structured interview. We thematically analysed participants’ responses regarding their professional challenges, and measured oncologists’ knowledge of genetics and confidence with somatic and germline molecular test results. Both groups described positive early experiences with PRISM but were cognisant of managing parents’ expectations. Key challenges for clinicians included understanding and communicating genomic results, balancing biopsy risks, and drug access. Most oncologists rated ‘good’ knowledge of genetics, but a minority were ‘very confident’ in interpreting (25%), explaining (34.4%) and making treatment recommendations (18.8%) based on somatic genetic test results. Challenges for scientists included greater emotional impact of their work and balancing translational outputs with academic productivity. Continued tracking of these challenges across the course of the trial, while assessing the perspectives of a wider range of stakeholders, is critical to drive the ongoing development of a workforce equipped to manage the demands of paediatric precision medicine.
Highlights
Precision medicine, with its focus on matching recommended treatments to specific pathogenic molecular aberrations, is a promising and paradigm-shifting strategy in childhood cancer treatment [1,2].Access to precision medicine trials may be impactful for paediatric cancer patients with poor-prognosis malignancies [3,4]
Precision medicine has the potential to compound these emotional pressures by demanding new ways of working for non-genetics trained clinicians, including a heightened level of interdisciplinary engagement and increased familiarity with genomic medicine [2,6,7,8,9,10]
All scientists had been involved in TARGET, the PRecISion Medicine for Children with Cancer (PRISM) pilot
Summary
Access to precision medicine trials may be impactful for paediatric cancer patients with poor-prognosis malignancies [3,4]. Precision medicine trials can offer hope to families, but are imbued with complexities at both a scientific and healthcare-systems level, introducing new challenges for all stakeholders [2]. Precision medicine has the potential to compound these emotional pressures by demanding new ways of working for non-genetics trained clinicians, including a heightened level of interdisciplinary engagement and increased familiarity with genomic medicine [2,6,7,8,9,10]. Despite growing evidence that clinicians are hopeful about the clinical utility of precision medicine [11], they may not feel adequately skilled to interpret and communicate the results of advanced genomic sequencing to patients and their families [12,13]. Non-genetics-trained clinicians may feel diffident interpreting and utilising information about germline variants in cancer predisposition genes [11,14]
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